The tibial stress fracture is a common injury among triathletes and cyclists with a high training load, especially those who combine intensive carrera sessions with long rides on road bikes or demanding routes on mountain bikes.
This type of fracture presents with diffuse pain in the ankle area, associated with effort, which initially disappears with rest but can become persistent if not diagnosed in time. The tibia, with its characteristic "S"-shaped axis, is designed to withstand axial loads, but it is in its distal part —about six centimeters above the ankle— where these injuries most frequently occur.
Since cyclists and triathletes often alternate endurance training with the impact of carrera running, it is important to identify the symptoms in time to prevent the fracture from progressing. An accurate diagnosis, based on clinical history and an adequate physical examination, is key to differentiating this injury from other conditions.
If you practice mountain biking or road cycling, it is advisable to complement your training with strengthening exercises and load planning to prevent bone wear and avoid this type of injury.
Causes of tibial stress fracture
Fatigue stress fractures occur in a bone without previous alterations, as a result of excessive load (repetitive trauma or excessive repetitive muscular activity), for which the bone structure is not prepared. There are a number of factors that predispose to this injury:
- Overtraining.
- Errors in carrera technique.
- Alterations in the biomechanics of carrera.
How is it diagnosed?
The diagnosis of these fractures is based on clinical history and physical examination. Clinically, the most important symptom is pain, which at the beginning is mild and diffuse after training in the area of the fracture, and disappears with rest. If not diagnosed and treated early, it persists even with rest and incapacitates the triathlete for their training. Performing a differential diagnosis with synovitis, tendinitis, tendinosis, or nerve entrapments using ultrasound diagnosis is essential to choose the appropriate treatment, since the fracture has a very different protocol. To confirm the diagnosis, the following imaging tests can be performed:
- Simple X-ray: where the first changes in the bone (sclerosis band, fracture line, periosteal bone formation) appear from the third week after the onset of symptoms.
- Tc99 bone scan: which shows increased uptake at the fracture line.
- CT scan: very useful for making a differential diagnosis.
- MRI: very sensitive and highly specific.
How to treat a tibial stress fracture
The treatment is fundamentally conservative, with immobilization not being necessary, but with a modification of activity for 6–8 weeks. In the acute phase, it is necessary to avoid weight-bearing on the leg with the fracture. Conventional physiotherapy (magnetotherapy, inflammation drainage, cryotherapy, etc.) is also recommended, as well as pharmacological treatment. In the chronic phase, treatment requires proprioception and strengthening. Returning to training after overcoming a tibial stress fracture should be progressive, starting with water exercises, non-weight-bearing, and gradually introducing weight-bearing and impact, under the supervision of the physical reconditioner and with periodic check-ups by the physiotherapist or podiatrist.